Miguel Antonio Salazar

Antimicrobial resistance (AMR) can worsen due to climate change. Several studies from China, Europe, and the USA have reported linear associations between weather and AMR. To provide additional evidence, this epidemiological study explored the nonlinear associations of short-term (28-day prior) and long-term (annual anomaly) temperature and rainfall exposure with AMR cases and multidrug resistance (MDR) at a single hospital in Pampanga, Philippines, a province with a tropical climate and high flood risk. Robust Poisson regression was used to estimate the associations between temperature and rainfall with AMR cases and the number of resistant antibiotics across subgroups of bacteria, priority pathogens, specimens, age, sex, and season. Several nonlinear associations exhibited an inverted U-shape, suggesting that the AMR risk peaks at specific temperatures or rainfall levels before declining at extreme values. Another recurring nonlinear association was U- or J-shaped, suggesting increased MDR severity or a greater number of resistant antibiotics with low or high rainfall. These findings underscore the possibility of a more complex link between climate and AMR, warranting further investigation across more locations and settings, whenever individual records are available. Future research should integrate ecological data to elucidate the mechanisms underlying these associations.

Wastewater-based epidemiology (WBE) of SARS-CoV-2 has been explored in many countries during the past years of the COVID-19 pandemic (2021-2022) along with cost-efficient large-scale monitoring of infection. In this study, samples (n=88) were collected for three consecutive months at four different sites (A - hospital, B - immediate hospital-government offices, C - residential, D - residential-commercial). RT-qPCR was used to quantify SARS-CoV-2 RNA, concentrations, specifically the N1 and N2 genes, in samples collected from a sewer network from a hospital to a community in the City of Manila, Philippines. Monte Carlo Simulation software was then used to compute the viral RNA prevalence in the wastewater matrix. Whole genome sequencing was then conducted to determine the emerging SARS-CoV-2 viral variants in wastewater. Results showed a higher detection rate of N1 genes compared to N2 genes. The highest concentration of viral RNA was obtained from Site A, while the lowest concentration was obtained from Site C. All 13 sequenced samples were representatives of Omicron variants, five of which were detected prior to their first detection in clinical samples. Notably, three Omicron subvariants were detected in both wastewater and clinical samples within the same sampling period. These show that SARS-CoV-2 RNA has potential as a biomarker for WBE in Manila, Philippines. However, further studies are needed to optimize the viral RNA recovery protocols and plans to recommend policies for efficient sewer line management should go hand in hand for the successful integration of this system in the City of Manila.

COVID-19 has turned into a protracted emergency to Philippine urban populations. The pandemic can be an opportunity for the country to strengthen surveillance capacity through wastewater-based epidemiology for COVID-19 and antimicrobial resistance. This capacity can translate to detection and monitoring for other emerging infectious diseases.

Environmental Health Perspectives is an Open Access journal published by the National Institute of Environmental Health Sciences. Environmental Health Perspectives is an Open Access journal published by the National Institute of Environmental Health Sciences.

Epidemiological studies have quantified the association between ambient temperature and diarrhoea. However, to our knowledge, no study has quantified the temperature association for severe diarrhoea cases. In this study, we quantified the association between mean temperature and two severe diarrhoea outcomes, which were mortality and hospital admissions accompanied with dehydration and/or co-morbidities. Using a 12-year dataset of three urban districts of the National Capital Region, Philippines, we modelled the non-linear association between weekly temperatures and weekly severe diarrhoea cases using a two-stage time series analysis. We computed the relative risks at the 95th (30.4 °C) and 5th percentiles (25.8 °C) of temperatures using minimum risk temperatures (MRTs) as the reference to quantify the association with high- and low-temperatures, respectively. The shapes of the cumulative associations were generally J-shaped with greater associations towards high temperatures. Mortality risks were found to increase by 53.3% [95% confidence interval (CI): 29.4%; 81.7%)] at 95th percentile of weekly mean temperatures compared with the MRT (28.2 °C). Similarly, the risk of hospitalised severe diarrhoea increased by 27.1% (95% CI: 0.7%; 60.4%) at 95th percentile in mean weekly temperatures compared with the MRT (28.6 °C). With the increased risk of severe diarrhoea cases under high ambient temperature, there may be a need to strengthen primary healthcare services and sustain the improvements made in water, sanitation, and hygiene, particularly in poor communities.

The impacts of climate change on human health have been observed and projected in the Philippines as vector-borne and heat-related diseases have and continue to increase. As a response, the Philippine government has given priority to climate change and health as one of the main research funding topics. To guide in identifying more specific research topics, a scoping review was done to complement the agenda-setting process by mapping out the extent of climate change and health research done in the country. Research articles and grey literature published from 1980 to 2017 were searched from online databases and search engines, and a total of 34 quantitative studies were selected. Fifty-three percent of the health topics studied were about mosquito-borne diseases, particularly dengue fever. Seventy-nine percent of the studies reported evidence of positive associations between climate factors and health outcomes. Recommended broad research themes for funding were health vulnerability, health adaptation, and co-benefits. Other notable recommendations were the development of open data and reproducible modeling schemes. In conclusion, the scoping review was useful in providing a background for research agenda-setting; however, additional analyses or consultations should be complementary for added depth.

The Zamboanga armed conflict was a 19-day long encounter in the Philippines in 2013 that displaced 119,000 people from their homes. This study describes the health consequences of this complex emergency in different age groups, time periods, and health facilities using data from Surveillance in Post Extreme Emergencies and Disasters (SPEED). This is a descriptive study of the SPEED database spanning 196 days of observation post-disaster and 1065 SPEED reports from 49 health facilities. Evacuation centers and village health centers, both primary care facilities, had the highest number of consults. Common infections and noncommunicable diseases were the most common reasons for consultations, namely, acute respiratory infections, fever, watery diarrhea, skin disease, and hypertension. Infections can be associated with environmental conditions in displaced populations, while hypertension has a high prevalence in the country and implies long-term care. Conflict-related injuries and deaths were not frequently observed due to the volatile situation that influenced health-seeking behavior as well as possible reporting gaps. In conclusion, in complex emergencies, as in natural disasters, wherein early alert and warning for potential outbreaks is crucial, SPEED can assist decision makers on response and recovery interventions. Linkages between SPEED and other surveillance and reporting systems need to be explored.